New DSM-5 Criteria For Autism -- Who Will Be Left Behind?

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http://www.forbes.com/sites/emilywillin ... ft-behind/

The article has a very valid point. The DSM working group are aware that they may be screwing things up.

http://www.dsm5.org/Documents/12-15%20DSM%20Commentary_Autism.pdf

This redefinition has its goods and its bad's. I do believe that the classification including social and communication difficulties but excluding repetitive behavior is concerning. Females Apies for example will often not display issues with communication (I am very much like this as well; I communicate well due to how well I have learned to adjust when speaking with others) however I am definitely an Aspie; I do have repetitive behavior however it does not impact my ability to perform daily task. My social and communication abilities are only evident by the fact that I do not have friends and have trouble developing and maintaining relationships as I do not understand social cues, body language and some facial expressions. I believe that the new Criteria could be effective in identify cases of autism however it will take exceptional evaluation from a psychologist or psychiatrist to diagnose Autism using these new Criteria. Many people who do have social and communication issues such as myself (and especially female Apies) mask it; so it will be interesting to see how this plays out. In our cases, we simply must remain firm with our diagnosis; educate ourselves on the criteria and explain which specific symptoms are relevant to us when dealing with our mental health providers.

Question: Do you find anyone with AS that has repetitive behaviour troublesome enough so they cannot function? If so, the probably are closer to OCD than Aspergers/Autism. There is nothing wrong with repetitive behaviour as long as it is not preventing you to function properly. That part of the diagnosis criteria can make it hard to differentiate between OCD and the Autism Spectrum, and if it is an on-the-edge case you may end up receiving the wrong assistance/help.

There are more pressing problems with the DSM 5 and Aspergers. Like the social/reciprocity criteria, which is something you learn to adapt in many cases with Aspergers. My ability to communicate and express myself clearly is way better than most normal people, so i (as i am now as a grownup) do not match the criteria. However, they do diagnose you from the person you were when you were a kid and i hope they continue with that (as described "C. Symptoms must be present in early childhood (May not become apparent until social demand exceeds limited capacity)").



Like it will with the criteria now, but people are still misdiagnosed because of morons who are unable to read the f*****g thing (DSM). In some cases that i've read about here on Wrong Planet, when it comes to getting a diagnosis, you are better off rolling a dice. How many psychopats are misdiagnosed with Aspergers? How many with Borderline?


Question: Do they also mask it during a diagnosis? if so, they got themselves to blame. Unless you are frank with your psychologist, don't expect anything to go well.



Speaking of "educate ourselves on the criteria", please read below, especially the highlighted sections.


The diagnosis criterias currently are:


You can read on about the proposed changes HERE (Click)

I havent got access to the latest draft of DSM5 (if anyone do, please post a link).

I sense great frustration and even a bit of anger from you. I am able to explain myself completely to my therapist and Psychiatric Nurse Practitioners; they all tell me that if I didn't inform them of my condition they would know. I am more intelligent, well composed; animated and expressive than the typically patients they see with Asperger's. There are different points on the spectrum; its not that I am not being honest; however I continue my learned behavior; I don't suddenly become nervous; I don't suddenly display of a lack of being able to show empathy; utilize listening; and read gestures. I struggle with these things but I do not completely misunderstand them. Female Apsies are often forced to get with the program or else; being able to socialize and fit into social settings is more important for them. I think you are not being fair in your evaluation. All Aspies are different; judging us or lumping us by specific criteria is just as bad as what the DSM is doing. Yes, people are still misdiagnosed; Mental health providers aren't perfect; Information only became available to Psychologist on Asperger's in the 1994 DSM and it didn't become well studied and diagnosed until starting in the 2000's. We have to be our own Doctor. We have to put ourselves first and fight for ourselves. If something isn't right, we have to keep searching until we find out what it is.

Way off, i never get frustrated, and if i were angry, i'd call you an idiot or something similar. I haven't done that - yet.



So am i. I have a high IQ, i've learned to cope with pretty much everything that Aspergers threw at me, except the forming of relations part. I am almost 40, have a job, an apartment and have almost paid off my student loans. I appear normal to people and most people wonder what the problem is, its not until i explain WTF Asperger is, then they understand. They think everyone with any autism spectrum disorder is Rainman - or (worse, now thanks to ret*d journalists) a serial killer.



A lack of empathy is not something you want to associate with Autism. Its a distinct diagnosis criteria for Psychopathy.

I have empathy. I have always had it, but i have very little sympathy for neurotypicals, given the experience i've recieved from them in life. I care about animals and homeless people, joe-average can go f**k himself: i dont care if they loose their jobs, have to move out of their pricey house, have to live on welfare and feel like they are shunned from society - all i can say is "Welcome to my world" - i have been there and noone gave a crap about me or my family.



I haven't done that at all. I think you need to reread my post.

The final text revision likely will not be available until the release in May, but the Chair of the DSM5 working group committee, Sue Swedo, has released further details on the finalized criteria, at the link below in the video from the APA website. She indicates that RRBI's can be met by history alone, but the three mandatory criterion elements of observed behavioral impairments in the Social Communication Criterion are what she describes as a source of impairments over the full course of life.

So, in other words technically according to Swedo a person will be able to be diagnosed without significant difficulties in RRBI's, as long as they are met by history, but the new 3 mandatory observed behavioral impairments are required assessed for an actual diagnosis through the course of a lifetime.

Of course the reality of diagnosis, beyond what is in the new diagnostic manual is ultimately determined by the judgement of the diagnosing professional. The new 3 mandatory Social Communication elements of observed behavioral impairments are broadly enough described where the personal judgement of the diagnosing professional can make the difference in who is or who is not, diagnosed with ASD.

http://www.psychiatry.org/practice/dsm/ ... grucC.dpuf

So, as i read that - if you had it at least once for 5 minutes in any point in life, you'll be diagnosed.

https://sfari.org/news-and-opinion/news ... -disorders

According to the DSM5 latest public revision released, quoted below from the link above, the "symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)".

ASD is still described as a neurodevelopmental disorder from early childhood in the DSM5 manual. But, technically it is the mandatory observed behavioral impairments as described in the criterion elements in Social Communication that are required for diagnosis, excluding RRBI's, per Sue Swedo in the video, that may have been accommodated in adaptation where there are no longer observed behavioral impairments in RRBI's.

The diagnosing professional is going to be looking for some type of an historical account of those symptoms from early childhood from medical records, to a guardian or caregiver, or what would likely have to be the person going in for the diagnosis in adulthood, if these records and accounts from others are not available. If the diagnosing professional follows along with the DSM5 guidelines.

When the actual DSM5 final revision is published, the diagnostic features in the expanded text of the manual that go well beyond what is released to the general public, unless one pays to read those details, will likely provide much more detailed parameters of diagnostic features to guide the diagnosing professional to a proper diagnosis.

The description in the link was very good, it went in deep and described it a bit more than -Uuuh....a lack of social reciprocity or sumthin', something that have been very open to interpretation.

Yes, and that is actually still only the basic criteria set for the last public revision of the DSM5 ASD basic criteria set. There is also a severity list of specific impairments, that wasn't listed in that link, and may be refined in the final revision of the DSM5, yet to be seen. And the diagnostic features are likely to be several pages in detail, as the current diagnostic features in the DSMIV are much more detailed than the basic criteria set.

As an example this is what the expanded text in the DSMIV looks like for autistic disorder and Asperger's syndrome, as quoted in the links below. It is much more detailed than the basic criteria set. It includes expanded text for diagnostic features directly associated with the basic criteria set, as well as associated features, and other information.

https://sites.google.com/site/gavinboll ... for-autism
https://sites.google.com/site/gavinboll ... -aspergers

Shrinks told me I still meet the criteria, therefore I'll probably be re-diagnosed with HFA.

DSM-V - Autism Spectrum Disorder

Must meet criteria A, B, C, and D:

A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:

1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

D. Symptoms together limit and impair everyday functioning.

Not so. As an adult, you may have spent a lifetime coping and learning masking behaviours, you are on auto-pilot having had to do it for so long. Aspies are niaive, and would not necessarily realise if it wasn't explained to them, that they had to strip this mask back and be their true self during an assessment. They would, again, niaively expect that the clinician knows how to get to the truth below, because they are the expert and you trust them. They are supposed to dig down and analyse and ask the right questions. I know, because it happened to me when I first went to get assessed and they failed to diagnose me.

Also, if you have spent a lifetime feeling different, finding things stressful and difficult and been used to others blaming you, you just know something's wrong but you don't know what, and unless you find out chapter and verse about Asperger's, if you haven't spent sufficient time in self-analysis, self-reflection and realising what behaviours you have (always hard to be objective about yourself) then you will not know how to respond to clinicians.

Don't forget, that communication is also not our forte, and face-to-face with people is very hard to say what you want to say, you become unfocused and forget things, especially if there is a team of professionals there.

That's not even touching on the fact that being a spectrum, it manifests differently in every individual on it, and doctors often try too hard to rigidly fit you into the listed diagnostic criteria, without any flexibility as to how those criteria manifest in you as a person.

Finally, they are slowly but finally waking up to how women with autism present, which is not exactly the same as men, so the diagnostic criteria need to be changed to take women's traits into account. Until they are, clinicians will be working from a half-finished book.

BTW...



...empathy is known to be affected in autism, otherwise why do you think they use the Empathy Quotient as part of the SBC tests for Asperger's? There is plenty of research out there about how empathy is impaired in people on the spectrum (whatever the actual truth of the matter is).

With that I don't see how people on the spectrum would be excluded......also what people don't realise is the DSM is a guide of mental illnesses and their basic presentation/symptoms. It cannot be used alone to diagnose someone it more can help point the psychiatrist/psychologist in the right direction based on what they observe. Sure its not a perfect system but its not as though people with an Aspergers Diagnoses, are going to then not be considered on the autism spectrum because they don't fit perfectly into the DSM criteria. The fact that even before the changes Aspergers was still considered to be an autism spectrum disorder people diagnosed with it would keep the ASD diagnoses.


I also would have to wonder if someone has no struggles related to any of that, why they would want a diagnoses anyways...i mean based on that it seems it would mostly be those people who get 'left out' not people impaired by the disorder.

Last edited by Sweetleaf on 02 Mar 2013, 1:17 pm, edited 1 time in total.

The news article you link has many points of screwy reasoning. The author seems to think any disability that could potentially impact social interaction counts as a social disability (which, if taken to its extreme, could mean lumping in kids with purely physical disabilities on the autism spectrum simply because other kids think drooling is gross). I also do not see how criteria A3 at all requires language impairment. And her proposed solution - identify symptoms, not syndromes - ignores the fact that the same symptom can need different treatment based on different underlying syndromes.